Revised December 2019

Patient Handbook Your Stay page 6

Speak Up! Ask questions and voice concerns page 15

Don’t Leave Until... From hospital to home page 25 In This Guide Welcome to Ascension St. Mary’s Hospital 3 About Us 4 Telephone Directory & Channel Listing 5 Facts About Your Stay 6-11 Visitor Passes 6 Visiting Hours 6 15 Speak Up Visitor Guidelines 6 Take charge of your care. Public Restrooms 6 Parking 6 Your Room 7 Housekeeping Services and Linens 7 Telephone 7 Video Surveillance for Patient Safety 7 Interpreters 7 18 For the Hearing Impaired 7 Stay Safe Valuables 8 You can contribute to healthcare safety. Wireless Internet Service 8 Security 8 Internet Access 8 Practice Drills 8 Cellphones 8 Hospital Safe 9 Lost and Found 9 OUR ADDRESS Medications From Home 9 800 S. Washington Ave. Smoking 9 Saginaw, MI 48601

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Facts About Your Stay continued Electrical Devices 9 Latex-Safe Environment 9 Cafeteria 10 Vending Machines 10 Patient Meal Service Information 10 Gift Shop 10 Hospitality House 11 17 Do You Have Pain? Spiritual Care 11 Make your stay as Mail and Flowers 11 comfortable as possible. Hotels/Motels 11 ATM 11 Rights & Responsibilities 12-14 Speak Up! 15 Ask Your Doctor 16 Do You Have Pain? 17 Stay Safe 18-19 25 Don’t Leave Until... What Are Your Advance Directives? 20-22 6 things you should know Your Privacy & Health Information 23-24 before you walk out the door. Don’t Leave Until… 25-26 Preparing to Leave the Hospital 27-30 For the Caregiver 31 Your Healthcare Team 32-33 Making a Gift to Ascension St. Mary’s 34 Patient Satisfaction 35 31 Compliments and Concerns 36 For the Caregiver Notice of Nondiscrimination 37-38 Your role as patient advocate. Notes 39-40

2 : Ascension.org/Michigan 989-907-8000 Welcome to Ascension St. Mary’s Hospital

Welcome to Ascension St. Mission Statement Mary’s Hospital. Our top priority Rooted in the loving is making your stay with us as ministry of Jesus as comfortable as possible. In our healer, we commit effort to assist you, we offer you ourselves to serving all this guide, which provides useful persons, with special information about our services, attention to those who policies and patients’ rights. are poor and vulnerable. Our mission is to improve the Our Catholic health health of our community. We are guided by our Values, ministry is dedicated which call on us to meet the needs of our patients and to spiritually centered, exceed their expectations. The commitment to quality holistic care, which care extends far beyond the walls of Ascension St. Mary’s, sustains and improves where we practice a shared belief that the very best the health of individuals care starts with a faith-based mission—with a focus on and communities. We treating the entire person, body, mind and spirit. are advocates for a Our staff welcomes sincere comments on our service. compassionate and just Your concerns or questions are helpful and may be directed society through our to the Nurse Manager, the Director of Patient Care or actions and words. to the Patient Relations Coordinator at 989-907-7532. You may be randomly selected to participate in a survey Core Values regarding your hospital stay. Your feedback assists us in Service of the Poor: continually improving the quality of care and service to our Generosity of Spirit, patients, families and visitors. Of course, we also welcome especially for persons compliments when earned by our staff. most in need On behalf of our physicians, nurses, volunteers and the Reverence: Respect entire staff at Ascension St. Mary’s, I would like to thank and compassion for the you for putting your trust in us. dignity and diversity of life Integrity: Inspiring trust through Sincerely, personal leadership Wisdom: Integrating excellence and Stephanie Duggan, MD stewardship Regional President, Northern Ministries Creativity: Courageous innovation Dedication: Affirming the hope and joy of our ministry

Ascension.org/Michigan 989-907-8000 : 3 About Us

OUR ADDRESS Ascension St. Mary’s is a regional leader in advanced 800 S. Washington Ave. specialty care, offering comprehensive services in cardiac Saginaw, MI 48601 care, neurosciences, cancer care, orthopedics, emergency and trauma care. Ascension St. Mary’s is a verified Level II Your Opinion Trauma Center and certified Primary Stroke Center. With Counts 268 beds and over 20 specialty centers throughout the Great Soon after your Lakes Bay Region, we are recognized as a technological discharge, you may pioneer and patient advocate throughout the state. receive a telephone For 145 years, Ascension St. Mary’s has provided high- call or mail survey on quality, compassionate and personalized care to individuals behalf of Ascension from more than 60 counties. We remain committed to St. Mary’s. Please take our Mission as we expand our outreach and impact as the time to speak with Ascension St. Mary’s is part of Ascension, one of the the representative or leading nonprofit and Catholic health systems in the complete and return United States. This means more options for health and the survey in order wellness needs, more access to a connected, integrated to share your opinion group of medical professionals, and an enhanced patient on how well we experience. The personal relationships between patients delivered your care and their doctors and nurses always will remain steadfast. during your hospital Together, we are dedicated to providing compassionate, stay. Your feedback personalized care in our community. is an important part of ensuring that we Healing Environment provide excellent care. Studies clearly show that a whole range of environmental factors–including lighting, color, aroma, views, art, sound and materials–has a powerful healing and therapeutic effect on patients. Healing environments may lead to faster patient recoveries, reduced pain, greater patient satisfaction and reduced stress levels among visitors and staff. Ascension St. Mary’s is continually seeking ways to enhance the healing environment. The artwork in Ascension St. Mary’s is not just for decoration. It is for healing. Art communicates humanity, and it softens the environment. When people view works of art that inspire positive memories or experiences, their feelings of hope and lightheartedness stimulate their immune systems. Studies have shown that patients who view nature or artwork may recover faster.

4 : Ascension.org/Michigan 989-907-8000 Telephone Directory & Channel Listing

Administration 907-8325 MAIN NUMBER Case Management/Social Work 907-8120 989-907-8000 Compliments/Concerns/Complaints 907-7532 Ethics Council 907-8195 Billing/Financial Housekeeping 907-8179 Counseling Patient Meal Service 907-8123 989-907-7585 Security 907-8128 Spiritual/Pastoral Care 907-5624 Gift Shop 989-907-8197 Please visit us at Ascension.org/Michigan. Medical Records Calling a Department WITHIN the Hospital? 989-907-8081 Dial the last four digits of the number.

TV Channel Listing 3 CBS 24 MSBNC 44 Freeform 4 NBC 25 TNT 45 Travel Channel 5 CW 26 TBS 46 truTV 6 ABC 27 FX 47 Comedy Central 7 FOX 28 USA 48 E! 8 PBS 29 A&E 49 Disney Channel 9 MyTV 30 AMC 50 Nickelodeon 10 Weather Channel 31 Bravo 51 Cartoon Network 11 ESPN 32 Oxygen 52 Animal Planet 12 ESPN2 33 TLC 53 Discovery Channel 13 FS Detroit 34 Paramount Network 54 MTV 14 FS Detroit Plus 35 Syfy 55 VH1 15 BTN 36 Food Network 56 CMT 16 Fox Sports 1 37 History 57 BET 17 Golf Channel 38 Lifetime 58 EWTN (Catholic 18 MLB Channel 39 Hallmark Channel Network) 19 NBC Sports Network 40 HGTV 59 Univision 20 Fox News Channel 41 GSN 60 National Geographic 21 CNN 42 Turner Classic 61 ION Television 22 HLN Movies 62 Investigation 23 CNBC 43 TV Land Discovery Shhh … Keep your TV down… Televisions are provided in each patient room. Please be considerate of others by keeping the TV volume down and turning off your TV at bedtime.

Ascension.org/Michigan 989-907-8000 : 5 Facts About Your Stay

Critical Care Unit We have policies and procedures in place to help you Visiting Hours and your family work with your doctors, nurses and staff Visitation guidelines will to get the most from your hospital stay. Please take a few be shared with you upon minutes to review these guidelines with your loved ones. admission. Children visiting in critical care Visiting Hours units may need to Recommended: 8:30 a.m. to 8:30 p.m. follow some additional It is recommended that a maximum of two visitors, guidelines. Please check including a spouse/significant other, visit at one time with the nurse. so the patient can rest better and the delivery of care will not be affected. We understand that injury and Visitor Passes illness affect all members of a patient’s family, including If a visitor is to remain children. Children (under the age of 16) are allowed to or arrive after 8:30 p.m., visit, although they must be under adult supervision at a visitor pass must be all times. Arrangements in other areas may be considered obtained from Security, based upon patient and family needs. which is located in the Emergency Visitor Guidelines Department. The We encourage visitors for emotional support and Emergency Department recovery. To provide a restful and safe environment, we is the only after-hour ask that all visitors comply with the following guidelines: access to the hospital. n Be considerate of other patients by keeping noise to a minimum. Quiet Time n Refrain from visiting if you have a cold, sore throat Ascension St. Mary’s has or any contagious disease. Quiet Time hours from n Observe no visiting and precaution signs before 2:00 p.m. to 4:00 p.m. and entering the room. 11:00 p.m. to 4:00 a.m. n Do not smoke. Studies show that sleep n Leave the room during tests or treatments if asked. is important for healing. We ask all patients, visitors Public Restrooms and associates to help Please do not use the bathrooms in patient rooms. us keep a quiet, healing They are reserved only for patients in order to protect environment. their health. Public restrooms are located throughout the hospital.

Parking Parking is available in the main visitor lot directly across from the entrance to the hospital The lot is patrolled by our security officers 24 hours a day.

6 : Ascension.org/Michigan 989-907-8000 For everyone’s health and safety, visitors should not use patient bathrooms.

Your Room Interpreters Your room is designed to support your care as well as your If you or your family safety. It has been carefully chosen for you based on the type is having trouble of medical care you will need and the appropriate nursing communicating unit that can provide that care for you. If you would prefer a in English or if language private room, every effort will be made to obtain one, based services are needed, on availability. If your room is too hot or too cold, please please let us know. inform your nurse or the person who cleans your room. Interpreters are available to assist you at no Housekeeping Services and Linens charge. Please contact Your room will be cleaned daily by a member of our your nurse or the Patient environmental services staff, with complete bed linen Relations Coordinator at changes done on an as-needed basis. Please notify your ext. 7532 for assistance. nurse to request a linen change. If you have a specific housekeeping request, call Environmental Services at For the Hearing ext. 8256. Impaired A telecommunications Telephone device (TDD) or volume- Your bedside telephone has an individual number, so controlled hearing- your family and friends can call you directly. There is no impaired telephone is charge for incoming or internal calls. When calling a available to help hearing- hospital number from inside Ascension St. Mary’s, dial impaired patients or the last four digits. patients who want to When making an outgoing call, you must first dial 9 then communicate with a enter the local seven-digit phone number. If you need to hearing-impaired relative make a long-distance telephone call, please dial 0, and an or friend. Please ask the operator will assist you. nursing staff if you wish to obtain a TDD. Video Surveillance for Patient Safety Ascension St. Mary’s incorporates the use of video surveillance for patient safety in most of the rooms in the intensive care units. Video surveillance may be used in non-intensive care rooms as ordered by a physician. Your right to privacy will be respected, and the video surveillance will be discontinued during personal patient care or treatment times. No images are recorded during video surveillance. If you have any questions about video surveillance in a patient room, please ask your nurse.

Ascension.org/Michigan 989-907-8000 : 7 Facts About Your Stay

Leave Your Security Valuables at Home A number of uniformed officers may be seen throughout If you have valuables, the building and grounds. They are here to help you. such as jewelry, credit Should you need assistance, call ext. 8128. A security cards and cash, please officer can escort your visitors to their cars at night, if give them to a relative requested. A 24-hour closed-circuit television surveillance or friend to take care of system is used throughout Ascension St. Mary’s and during your stay. operated by staff in our Security Department. Store your contact lenses, eyeglasses, Internet Access hearing aids and To access the guest network, dentures in containers 1. Right click on wireless icon in lower right-hand labeled with your name corner of desktop. and place them in a 2. Click “View available networks.” drawer in your bedside 3. Choose “AH-Guest.” table when not in use. 4. Open Internet Explorer. Please don’t put them on 5. When Internet Explorer opens, you will receive your bed or food tray— a security warning you must agree to before you they may be damaged are able to browse the internet. Please read through or lost. the security warning, then click on “Accept” Ascension St. Mary’s is not responsible for Practice Drills replacement of personal While you are a patient, the staff may be involved in a fire belongings. or disaster drill. These drills are held to ensure maximum safety for our patients. Please do not become alarmed if Wireless Internet you hear loud bells, which signal an alarm. You and your Service visitors should remain in your room during a drill and wait Wireless internet for further instructions from the staff. If a real emergency communication devices arises, you will be advised and assisted as appropriate. may be used in patient rooms and waiting areas. Cellphones Patients and visitors Patients and visitors may use cellphones and similar must furnish their own devices in designated public areas only. They include internet devices. Please all visitor waiting areas, hospital cafeteria and the see Internet Access on lobby areas. Cellphone and camera phone usage are how to connect to Wi-Fi. discouraged in patient care areas or any area of the hospital where patients are being treated or examined.

8 : Ascension.org/Michigan 989-907-8000 Hospital Safe Electrical Devices While you are here, do not bring jewelry, credit cards Electrical devices, or large amounts of money with you. If you have those including hairdryers, items with you, they should be sent home as soon as curling irons, razors, possible. Until you can make these arrangements, you radios, heating pads, may store your valuables in the hospital safe. Please personal fans and contact the Security Department, ext. 8128, for more portable heaters, information. Ascension St. Mary’s does not assume computers and other responsibility for your personal belongings. devices, are not permitted in patient Lost and Found rooms. You may use only Should you or your visitors misplace any belongings battery-operated devices. while you are here, please notify your nurse to report any lost items. If you notice a missing item after you’ve been Latex-Safe discharged, please contact Security at 989-907-8128. Environment Ascension St. Mary’s is not responsible for Ascension St. Mary’s replacement of personal belongings. strives to provide a latex-safe environment Medications From Home so that we may deliver Unless requested by the hospital, please do not bring care to a patient with a any medications (prescription, over-the-counter, herbal, latex allergy. Therefore, nutraceutical or other products) to the hospital for NO LATEX BALLOONS personal use or self-administration. All medications you ARE ALLOWED in the take while a patient at Ascension St. Mary’s are being hospital. Mylar balloons carefully prescribed and monitored by your physician, are acceptable and dispensed by pharmacists from the hospital pharmacy, available in our gift shop. and administered by trained professionals. To optimize your safe care while in the hospital, patients are not permitted to administer their own medications or to keep medications at their bedside. Nursing and pharmacy associates can facilitate return of your medications to family or temporary safe storage of your medications within the secured pharmacy department until your discharge.

Smoking To comply with state law and to provide a healthy Ascension St. Mary’s environment for our patients, visitors and staff, smoking is a tobacco-free is not permitted in the hospital or on the grounds. This campus. includes all Ascension St. Mary’s off-site locations.

Ascension.org/Michigan 989-907-8000 : 9 Facts About Your Stay

Where’s the Cafeteria Cafeteria? A large variety of items is available, including a salad bar, Location pizza, grill-to-order and specialty items. Second floor Visitors are welcome to Patient Meal Service Information dine in the cafeteria. Our patient meal program is called Three Square. Our goal is for you to have fewer interruptions from Food and Hours Nutrition, allowing the rest you need to heal. Breakfast Our seven-day menu includes culinary creations made 6:30 a.m. to 10:30 a.m. with fresh ingredients just for you. During each meal Lunch period, your Culinary Ambassador will deliver our 11:00 a.m. to 2:00 p.m. featured entrée. The Chef ’s Specials are meals proven to Midday be our patients’ favorites and are based on your doctor- 2:00 p.m. to 4:30 p.m. prescribed diet order. However, if you decide you would Dinner rather have something else, you may call the Food 4:30 p.m. to 7:30 p.m. and Nutrition Department using the number on your menu (8123), and an associate will help you make an Vending Machines alternate selection from our culinary favorites. We also A fully stocked vending offer continental/lite fare between our hot meal service room is available inside periods. We’ve coordinated a set time with nursing on the cafeteria for those each unit for breakfast, lunch and dinner deliveries. times when the kitchen You are encouraged to contact Food and Nutrition is closed. before your designated meal service time if an alternative is desired. If you have any questions about your diet, let your Culinary Ambassador know you would like to see a Dietitian. Your guests may order a guest tray that will be delivered to your room. All guest trays are $6 and include the Chef ’s Special of the day. The guest tray must be purchased in the cafeteria and ordered in advance of the meal service period. Bon Appetit!

Gift Shop For your convenience, a gift shop is located on the first floor of the hospital. The gift shop offers many items, including giftware, clothing, toiletry articles, snacks, fresh flowers and magazines. We realize it is not always possible for patients to leave their room. If you wish to purchase items from the gift shop, the gift cart can bring items to your room.

10 : Ascension.org/Michigan 989-907-8000 Hospital volunteers take the gift cart to patient rooms on ATM a regular basis. An ATM is located on Hours: the first floor of the Monday through Friday: 9:00 a.m. to 5:30 p.m. hospital, down the hall from the gift shop at the Hospitality House main entrance. Visitors and families are encouraged to take needed time away from the hospital. For families who live a considerable distance away, the Emerson Hospitality House is a “home away from home” located on the Ascension St. Mary’s campus. The house is open 365 days a year, 24 hours a day and can accommodate up to 10 guests. There are comfortable guest rooms as well as a kitchen and laundry facility. A donation of $25 per night is requested for the first guest, and $10 a night for each additional guest. If you would like to stay at the Hospitality House, ask your nurse, social worker or pastoral care staff, and they will give you the necessary referral and more information.

Spiritual Care Hospital chaplains are available to all patients and their families. Please contact your nurse to request a chaplain in Spiritual Care Services. A chapel is on the first floor, and Mass is held weekly. Eucharistic ministers for daily communion also are available. Please contact Spiritual/ Pastoral Care at ext. 5624 for more information.

Mail and Flowers Flowers and mail will be delivered to your room on a daily basis. Any mail that arrives after you have been discharged will be forwarded to your home. Please note that flowers are not allowed in intensive care units. Postage stamps are available in the gift shop, and a mailbox for sending mail is located right outside the main entrance.

Hotels/Motels Area hotels and motels offer a special discount rate for guests who have family members in the hospital. Be sure to ask the hotel front desk staff if it offers this discount.

Ascension.org/Michigan 989-907-8000 : 11 Rights & Responsibilities

As a patient at an Ascension Michigan of your race, creed, culture, religion, facility, you have the right: national origin, language, color, 1. To be involved in decisions about the age, disability, marital status, sex, care, treatment and services provided. sexual orientation, gender identity or These decisions include the right expression, level of income or source to receive or refuse care, treatment of payment. and services without coercion, 6. To receive respectful attention to your discrimination or retaliation, or confidentiality, privacy, dignity and having someone of your choice security. exercise your rights if you are 7. To exercise your religious practice and incapable of doing so, in accordance cultural and personal values, beliefs with laws and regulations. You will and preferences, within legal and be asked to consent to treatment or safety guidelines. services that have been explained to 8. To have the person of your choice you in terms you understand. informed, as soon as possible, when 2. To create an advance directive and you are admitted to an Ascension have the hospital staff comply with Michigan facility. You also have the these directives. The existence or lack right to have your private physician of an advance directive shall not affect contacted. your right to access care, treatment 9. To know the name, professional status and services. and relationship of any provider of 3. To execute a do-not-resuscitate order care, treatment or services to the on your behalf and have the hospital Ascension Michigan facility, and to staff follow it. Your patient advocate know the reason for any proposed may also execute a do-not-resuscitate change in the professional staff order on your behalf, in accordance responsible for your care. with applicable laws and regulations. 10. To receive assistance with your You or your patient advocate may communication needs, including revoke a do-not-resuscitate order at translation/interpretation services any time and in any manner by which and other communication aids, you are able to communicate your to ensure that you are able to intent to revoke the order, and such participate in your plan of care. revocation shall immediately become 11. To be informed of any research a part of your permanent medical studies that could be offered to you. record. You have the right to refuse to be 4. To be informed about the outcomes part of such research studies without of the care, treatment and services compromising access to, and quality provided, including any unexpected of, your care. outcomes. 12. To expect that your report of pain 5. To receive appropriate care regardless will be believed and addressed.

12 : Ascension.org/Michigan 989-907-8000 13. To have your wishes addressed consent for recording or filming. relating to end-of-life decisions, Recording or filming includes including organ donation. photographic, video, electronic or 14. To confidentiality of your clinical audio media. When the recording record, to view your record and to or filming is used internally for obtain, within a reasonable time, a performance improvement or copy of your record, including any education, your consent is part of completed laboratory test results. the general consent to treatment There may be a charge for this. You form. When the recording will be have the right to refuse the release used for external purposes, such as of your clinical record to a person marketing, you will be asked to sign outside of an Ascension Michigan a separate consent that indicates the facility, except as may be required use of the recording or film. You by law, the right to request an have the right to request that any amendment to the medical record recording or filming be stopped. and the right to obtain information 19. To be informed about Ascension on disclosures of your health Michigan rules and regulations that information. affect patient care and conduct. 15. To be free from mental, physical, 20. To be provided information about sexual and verbal abuse, neglect and Ascension Michigan policies and exploitation while at an Ascension procedures for initiation, review and Michigan facility. You have a right resolution of patient concerns. to access protective and advocacy 21. To have complaints and concerns services. from you or your family addressed in 16. To be free from restraints, except in a timely manner. emergency situations. Your doctor 22. To a clean and safe environment. can order restraints only when Ascension Michigan facilitates an necessary to protect you and others ongoing, proactive program for from injury. identifying risks and improving 17. To receive, within a reasonable patient safety. period of time, an itemized bill 23. To designate a support person who for services rendered, and to be will provide you with emotional informed of the source of payment support during the course of for your services. your stay unless the individual’s 18. To be informed about the recording presence infringes on others’ rights, or filming of your care, treatment compromises safety, or is medically and services, which can be useful or therapeutically contraindicated. for many purposes. In order to 24. To receive and designate visitors not compromise your privacy and of your choosing, including, but confidentiality, we will obtain your not limited to, a spouse, a domestic

Ascension.org/Michigan 989-907-8000 : 13 Rights & Responsibilities

partner (including a same-sex health risks as you perceive them, domestic partner), another family and ask questions when you do not member or a friend. Ascension understand what you’ve been told Michigan shall not restrict, limit or about your care. otherwise deny visitation privileges 3. To notify your care provider or on the basis of race, color, national physician about changes in your origin, religion, sex, gender identity, condition. sexual orientation or disability. You 4. To notify your care provider or may withdraw or deny your consent physician of symptoms or healthcare to receive a visitor at any time. problems, even if they are not related 25. To question whether you are ready to your primary healthcare condition. to be discharged or transferred to 5. To report your pain and participate another facility. in the development of a pain 26. To be made aware of the reason management plan with your care for your transfer, either within or provider or physician. outside of the hospital. 6. To inform your care provider or 27. To receive assistance and physician if you do not understand information to prepare you and instructions or if you will be unable to your family for when you leave the follow them. hospital. 7. To accept the consequences of your 28. To select the provider for your post- actions if you choose not to participate hospital care, including the choice in the recommended treatment plan. of home health agency, medical 8. To observe safety regulations. equipment provider or nursing 9. To be considerate of patients, families home. and staff; help control noise and 29. To access protective and advocacy disturbances; and follow the smoking services. policies of the organization. 10. To not threaten or harm other Your Responsibilities patients, families or staff. We expect patients and visitors to 11. To not destroy the property of follow Ascension Michigan’s rules and patients, families, staff and facilities. regulations. These rules protect you and 12. To fulfill the financial obligations other patients. of your healthcare as promptly as As a patient at an Ascension Michigan possible. facility, you have the responsibility: 13. To ask about test results—do not 1. To participate to the fullest extent assume no news is good news. possible in your care and treatment. 14. To provide accurate identification 2. To provide complete information and information related to insurance about your healthcare condition and coverage. medical history, report your care and

14 : Ascension.org/Michigan 989-907-8000 Speak Up! Take charge of your care.

During your stay, the doctors, nurses and staff of your hospital will treat you and your family as partners in your own care. One important way that you can be involved is to speak up. Ask questions, voice your concerns, and don’t be afraid to raise any issues relating not only to your care and treatment, but also to overall hospital services. In the pages that follow, you’ll find a step-by-step guide to making the most of your hospital stay—how to stay safe, get the information you need, ask the right questions and interact effectively with your doctors, nurses and hospital staff.

STEP UP & SPEAK UP SPEAK UP: Ask questions and voice concerns. Remember: It’s your body, and you have a right to know. n Write down any questions you have PAY ATTENTION: Make sure you’re getting n Choose a support person the right treatments and medicines. to communicate with the doctors and staff EDUCATE YOURSELF: Learn about the n Keep a list of doctors medical tests you get and your treatment plan. you see and the meds they prescribe FIND AN ADVOCATE: Pick a trusted family member or friend to be your advocate or support person. Don’t Get Overwhelmed, Write It Down! WHAT MEDS & WHY: Know what medicines you take and why you take them.

CHECK BEFORE YOU GO: Use a hospital, clinic, surgery center or other type of healthcare organization that meets The Joint Commission’s quality standards.

PARTICIPATE IN YOUR CARE: You are the center of the healthcare team. Courtesy of The Joint Commission.

Ascension.org/Michigan 989-907-8000 : 15 Ask Your Doctor

During the course of your stay here at Ascension St. Mary’s Hospital, we would like to ensure that you and your family know your plan of care and feel comfortable asking questions about your care. If you have questions for your doctor, we encourage you to write them down on this form so that you can refer to them when the doctor visits with you.

Questions for the Doctor: 1.______

2.______

3.______

4.______

5.______

6.______

7.______

8.______

If for some reason you still don’t understand the information that your doctor has given you about your plan of care, please let him or her know so that he or she can clarify your concerns. Please know that you always can ask your nurse to clarify any questions that you might have about the information that your doctor has given you. Thank you for allowing Ascension St. Mary’s Hospital to serve your healthcare needs.

16 : Ascension.org/Michigan 989-907-8000 Do You Have Pain? Manage your pain so your hospital stay is as comfortable as possible. You are the expert about how you are feeling. Be sure to tell your doctor or nurse when you have any kind of pain.

To help describe your pain, be sure to report: n When the pain began. n Where you feel pain. n How the pain feels—sharp, dull, throbbing, burning, tingling. n If the pain is constant, or if it comes and goes. n What, if anything, makes the pain feel better. n What, if anything, makes the pain feel worse. n How much pain, if any, your medicine is taking away. n If your medicine helps with the pain, how many hours of relief do you get?

USE THE PAIN RATING SCALE BELOW TO TELL YOUR DOCTOR OR NURSE HOW YOUR PAIN IS AFFECTING YOU.

Ascension.org/Michigan 989-907-8000 : 17 Stay Safe You can contribute to healthcare safety.

While you are in the hospital, many people will enter PATIENT your room, from doctors and nurses to aides and IDENTIFICATION technicians. The following information will help make Any time staff your hospital stay safe and comfortable. members enter your room to administer medications, transport you or perform procedures and treatments, they must check your birth date and name before they proceed. At times, you may be asked the same questions repeatedly. We are aware that this may be annoying. Please understand, however, that this verification process is a critical component Employee ID in our patient safety All hospital employees wear identification badges. program in order to Feel free to ask any staff member for his or her name and guarantee that all of job classification. If you do not see an ID badge on an our patients receive the employee, please call your nurse immediately. correct medications and treatments.

Don’t Be Afraid to Ask… A number of people may enter your hospital room. Be sure to: n Ask for the ID of everyone who comes into your room. n Speak up if hospital staff doesn’t ask to check your ID. n Ask if the person has washed his or her hands before he or she touches you. n If you are told you need certain tests or procedures, ask why you need them, when they will happen and how long it will be before you get the results.

18 : Ascension.org/Michigan 989-907-8000 STAY SAFE Preventing Infections The single most important thing you can do to help prevent infections is to wash your hands and make sure that everyone who touches you—including your doctors and nurses—washes his or her hands, too. You, your family and friends should wash hands: 1. after touching objects or surfaces in the hospital room 2. before eating 3. after using the restroom Happy Birthday to You! Wash your hands with It also is important that your healthcare providers soap and warm water wash their hands with either soap and water or for 20 seconds. That’s an alcohol-based hand cleaner every time before about the same amount and after they touch you. Healthcare providers of time that it takes to know to practice hand hygiene, but sometimes they sing the “Happy Birthday” forget. You and your family should not be afraid or song twice. embarrassed to speak up and ask them to wash their hands. Preventing Falls Hospital patients often fall because they are weak or unsteady due to illness or medical procedures, their medications make them No Soap? No Problem. dizzy, or they’ve been sitting Alcohol-based hand or lying down for too long. cleaners are as effective Ascension St. Mary’s as soap and water in cares about our patients’ killing germs. To use, safety. Please help us apply the cleaner to keep you safe by not the palm of your hand getting out of bed and rub your hands by yourself. Your together. Keep rubbing hospital bed is probably higher and narrower than over all the surfaces your bed at home, and you can easily fall while trying of your fingers to get in or out of it. Please use your nurse call button and hands until and ask for assistance. they are dry.

Ascension.org/Michigan 989-907-8000 : 19 What Are Your Advance Directives?

What Are Advance Directives? A living will, healthcare proxy and durable power of attorney are the legal documents that allow you to give direction to medical personnel, family and friends concerning your future care when you cannot speak for yourself. You do not need a lawyer in order to complete advance directives.

Advance Directive Policy Essentially, these guidelines provide that The sponsor of Ascension St. Mary’s, life-sustaining treatment procedures can Ascension Health, a member of the be withheld or withdrawn only with Catholic Church, and in accordance with respect to those patients who have been the Ethical and Religious Directives for medically diagnosed as suffering from a Catholic Healthcare Services, reaffirms terminal illness or condition, or as being its belief in the dignity of human life and in a persistent vegetative state. the right of all patients to a dignified and natural death. What Does It Do? The durable power of attorney for Living Wills healthcare provides many benefits Living wills are not legally recognized for you and your family. Now, while in the state of Michigan. However, you still are able to make decisions the wishes expressed in a presented on your own behalf, is the time to living will, as well as other means of appoint a patient advocate. A patient communications, will be considered advocate is authorized to make any when family and physicians are faced medical treatment decision that you with withdrawal of treatment decisions. could make on your own behalf, Patients should state their treatment subject to the limitations set forth preferences in a valid durable power of in your designation form and as attorney for healthcare, which meets the limited by law. A patient advocate’s requirement of the Michigan law. powers are not limited to decisions concerning medical treatment itself, Power of Attorney but also extend to any determination Michigan law permits the appointment concerning your care and custody. of a power of attorney for healthcare to make medical treatment decisions What is the Physician’s Role? in the event that a person should Your attending physician plays an become unable to participate in medical important role in the implementation treatment decisions. The scope of this of the durable power of attorney for decision-making must lie within the healthcare. The patient designation established decisional parameters erected form is made part of your medical within Ascension St. Mary’s established record, and your attending physician withdrawal of treatment guidelines. and another physician determine

20 : Ascension.org/Michigan 989-907-8000 whether you are able to participate in discriminate against individuals medical treatment decisions. While who complete or do not complete you are unable to participate in medical a designation form. In addition, treatment decisions, the physician physicians and other healthcare obtains informed consent from the providers cannot require you to appoint patient advocate. a patient advocate as a precondition to providing healthcare services. What Are the Limits of a Durable Power of Attorney for Healthcare? Is a Durable Power of Attorney for The durable power of attorney for Healthcare Different Than a Living healthcare has several limitations. A Will or Medical Directive? designation form can be filled out only A designation form is not a living will when you are 18 years of age or older and or a medical directive. Both a living of sound mind. In addition, a patient will and a medical directive permit advocate’s powers become effective only you to state your wishes not to receive while you are unable to participate in life-sustaining treatment if you are medical treatment decisions. Therefore, terminally ill and treatment would only planning prior to your possible inability artificially prolong the dying process. to participate in medical treatment However, Michigan statutory law does decisions is extremely important. If you not recognize the so-called living will or want your patient advocate to be able medical directive and, thus, they provide to make decisions regarding organ and little assurance that your wishes will be tissue donation, it must be specifically carried out. There are no special legal stated on your designation form. A protections for doctors who voluntarily patient advocate may decide to withhold choose to follow your instructions or withdraw life-sustaining treatment, as stated in the living will or medical but only if you have expressly authorized directive. this in a clear and convincing manner A properly implemented durable and have acknowledged that death could power of attorney for healthcare, under result. This power always is subject to Michigan law, gives physicians legal your current desire to be provided life- protection for their actions. Unlike either sustaining treatment, and it cannot be the living will or medical directive, the exercised on behalf of a pregnant patient durable power of attorney for healthcare whose death would result. applies to all situations in which you are unable to make healthcare decisions for Do I Have to Appoint a Patient yourself, not just when you are terminally Advocate? ill. A durable power of attorney for You have the option to appoint a patient healthcare allows you to state any desires advocate but cannot be required to you may have concerning care and do so. Health and life insurers cannot medical treatment decisions, including

Ascension.org/Michigan 989-907-8000 : 21 What Are Your Advance Directives? a desire that you receive maximum and agrees to accept the responsibility treatment when you are terminally ill by signing the acceptance of patient or desires concerning health matters advocate portion of the designation unrelated to terminal illness. Only a form. You may identify a successor durable power of attorney for healthcare patient advocate to be contacted if your allows you to choose someone you primary patient advocate should become trust and who knows you well enough unable or unwilling to fulfill his or her to make healthcare decisions for you. responsibilities. You should not choose By discussing your healthcare desires a person who is reluctant to participate. with the person you have selected, you Please contact the Spiritual/Pastoral can best ensure that your wishes will be Care Department at ext. 5624, or respected if any unforeseen illness your nurse if you would like forms or injury leaves you unable to decide or assistance. for yourself.

Whom Can You Appoint to Make Organ Donation Healthcare Decisions for You? Michigan law requires that every You may appoint almost any adult to be patient’s family and/or patient your patient advocate. You may select a advocate be informed of the member of your family such as a spouse opportunity to donate tissues and/ or adult child, a friend or someone else or organs of the patient in the event you trust. However, before you fill out a of death. Your advance directive must designation form, you should discuss the provide documentation regarding matter with the person you have chosen your wishes for organ donation. and make sure that person understands

Notes

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22 : Ascension.org/Michigan 989-907-8000 Your Privacy & Health Information

You have privacy rights under a federal law that protect Your Information your health information. These rights are important for If you believe your you to know. Federal law sets rules and limits on who can health information look at and receive your health information. was used or shared in a way that is not allowed Who Must Follow This Law? under the privacy law, n Most doctors, nurses, pharmacies, hospitals, clinics, or if you weren’t able nursing homes and many other healthcare providers to exercise your rights, and their vendors you can file a complaint n Health insurance companies, HMOs and most with your provider or employer group health plans health insurer. You also n Certain government programs that pay for healthcare, can file a complaint such as Medicare and Medicaid with the U.S. government. Go online to https:// What Information Is Protected? ocrportal.hhs.gov/ocr/ n Information your doctors, nurses and other smartscreen/main.jsf for healthcare providers put in your medical records more information. n Conversations your doctor has with nurses and others regarding your care or treatment n Information about you in your health insurer’s computer system n Billing information about you at your clinic n Most other health information about you held by those who must follow this law

You Have Rights Over Your Health Information. Providers and health insurers who are required to follow this law must comply with your right to: n Ask to see and get a copy of your health records n Have corrections added to your health information n Receive a notice that tells you how your health information may be used and shared n Decide if you want to give your permission before your health information can be used or shared for certain purposes, such as for marketing n Get a report on when and why your health information was shared for certain purposes n File a complaint

Ascension.org/Michigan 989-907-8000 : 23 Your Privacy & Health Information

A separate law To make sure that your health information is protected provides additional in a way that doesn’t interfere with your healthcare, your privacy protections information can be used and shared: to patients of alcohol n For your treatment and care coordination and drug treatment n To pay doctors and hospitals for your healthcare and programs. For more help run their businesses information, go online n With your family, relatives, friends or others you to www.samhsa.gov. identify who are involved with your healthcare or your healthcare bills, unless you object n To make sure doctors give good care and nursing homes are clean and safe n To protect the public’s health, such as by reporting when the flu is in your area n To make required reports to the police, such as reporting gunshot wounds

Without your written permission, your provider cannot: n Give your health information to your employer n Use or share your health information for marketing or advertising purposes n Share private notes about your mental health counseling sessions

Adapted from U.S. Department of Health & Human Services Office for Civil Rights

24 : Ascension.org/Michigan 989-907-8000 Don’t Leave Until… 6 things to know before you walk out that hospital door.

Be sure to meet with the hospital’s discharge planner early in your stay to ensure a smooth discharge process later on.

When it’s time to be released from the some other title. You and your caregiver hospital, your physician will authorize should meet this person relatively early a hospital discharge. This doesn’t in your hospital stay; if not, find out who necessarily mean that you are completely this person is and be sure to meet with well—it only means that you no longer him or her well before your expected need hospital services. If you disagree, discharge date. you or your caregiver can appeal the decision (see If You Disagree, Right). If You Disagree On the other hand, you may be pleased You or your support person can appeal to learn that your doctor has approved your doctor’s discharge decision. If you your discharge. But before you can leave are a Medicare patient, be sure you the hospital, there are several things that are given “An Important Message from you or your caregiver must attend to. Medicare” from the hospital’s discharge The first step is to know who will be planner or caseworker. This details your involved in your discharge process. rights to remain in the hospital for care This starts with the hospital’s discharge and provides information on who to planner, who may be a nurse, social contact to appeal a discharge decision. worker, or administrator, or may have

Ascension.org/Michigan 989-907-8000 : 25 DON’T LEAVE UNTIL

Make sure you have the 4. Follow-up care instructions. following information before Make sure you have paperwork that you leave the hospital: tells you: n what, if any, dietary restrictions you need 1. Discharge summary. This to follow and for how long is an overview of why you were n what kinds of activities you can and can’t do, in the hospital, which healthcare and for how long professionals saw you, what n how to properly care for any injury or procedures were done, and what incisions you may have medications were prescribed. n what follow-up tests you may need and when you need to schedule them 2. Medications list. This is n what medicines you must take, why, a listing of what medications and for how long you are taking, why, in what n when you need to see your physician dosage, and who prescribed n any other home-care instructions for them. Having a list prepared your caregiver, such as how to get you in by the hospital is a good way to and out of bed, how to use and monitor double-check the information any equipment, and what signs and you should already have been symptoms to watch out for keeping track of. n telephone numbers to call if you or your caregiver has any questions pertaining 3. Prescription. A prescription to your after-hospital care for any medications you need. Be sure to fill your prescriptions 5. Other services. When you leave the promptly so you don’t run out hospital, you may need to spend time in a of needed medications. rehabilitation facility, nursing home or other institution. Or you may need to schedule tests at an imaging center, have treatments at a cancer Be sure to ask what foods center, or have in-home therapy. Be sure to to stay away from while speak with your nurse or physician to get on your medications. all the details you need before you leave. 6. Community resources. You and your caregiver may feel unprepared for what will happen after your discharge. Make sure your discharge planner provides you with information about local resources, such as agencies that can provide services like transportation, equipment, home care, and respite care.

26 : Ascension.org/Michigan 989-907-8000 Preparing to Leave the Hospital

When your doctor feels that you are ready to leave the When You Are hospital, he or she will authorize a hospital discharge. Please Discharged speak with your nurse about our discharge procedures. Your physician Here are a few tips to make the discharge process determines when you are run smoothly: ready to be discharged. n Be sure you and/or your caregiver has spoken with your Your physician and nurse nurse or a discharge planner and that you understand will give you discharge what services you may need after leaving the hospital. instructions and answer n Verify your discharge date and time with your any questions you nurse or doctor. have about managing n Have someone available to pick you up. your treatment and n Check your room, bathroom, closet and bedside table medications once you carefully for any personal items. are home. If you are n Retrieve any valuables you have stored in the confused or unsure about hospital safe. what you need to do, n Make sure you or your caregiver has all necessary what medications you paperwork for billing, referrals, prescriptions, etc. must take, or if you have to restrict your diet or Case Management/Discharge Planning activities, don’t be afraid If you desire assistance with discharge planning, please to ask and take notes. inform your nurse or physician, and a referral will be Be sure you understand made. A case manager will meet with you to identify any instructions you your needs and assist with developing a plan. Individuals have been given before in this department work with a variety of community you leave the hospital. agencies to help you and your family manage the issues that often accompany an illness. They also can assist you with referrals and discharge planning, which range from extended care facility placement, home care, hospital equipment, transportation, foster care, hospice, Meals on Wheels, Hospital Hospitality House (for family) and community support services. You have the right to refuse discharge planning or to comply with a discharge plan. Individuals in this department also provide assistance by offering support to patients and families in coping with the stress routinely associated with medical diagnoses and treatment, provide assistance in communicating with patients’ family and healthcare professionals, and can arrange for referrals for problems that require long-term treatment.

Ascension.org/Michigan 989-907-8000 : 27 Preparing to Leave the Hospital

Uninsured? Billing & Insurance A representative of At the time of patient registration, your insurance the Business Office information was obtained, and the staff should have will discuss financial photocopied your driver’s license and insurance card(s). arrangements with you. If your information was not photocopied at that time, You also may speak with please have a family member or visitor bring it to a hospital representative the Admitting Department, and a staff member will from the Social Services make copies at that time. It is important that patients Department to assist you familiarize themselves with the terms of their insurance in applying for Medicaid coverage and recognize and accept their responsibility or other government- for the payment of services received. The charges that are assisted programs. Please not covered by insurance are the direct responsibility of call 989-907-7585 for the patient. If there is a question about your insurance more information. coverage, co-pay, deductibles and coinsurance, please contact the financial counseling office or call your insurance company directly. Ascension St. Mary’s accepts payment of services through cash, check or credit card. For more information about using one of these payment methods, please contact 989-907-7585 for further assistance.

Non-Hospital Bills You May Receive If you have certain tests or treatments done in the hospital, you may receive bills from physicians that you did not see in person. These bills are for professional services rendered by these physicians in diagnosing and interpreting test results. You may receive separate bills from radiologists, emergency room physicians, pathologists and/or anesthesia services. These bills may cover such expenses as physician services and/or professional interpretation of tests. If you have questions or concerns in regard to these bills, please call the telephone number or write to the address printed on the statement. You should remember that your policy is a contract between you and your insurance company, and you have the final responsibility for payment of your hospital bill.

28 : Ascension.org/Michigan 989-907-8000 Pre-Certification If Your Insurance Most insurance plans now require pre-certification Company Does Not for hospital stays and certain tests and procedures in Cover All Expenses order for you to be eligible for full policy benefits. It is Ascension St. Mary’s has your responsibility to see that this is completed. This financial counselors that information can be found on your insurance card. If you can offer advice on what are unsure of your pre-certification requirements, we your insurance policy recommend that you contact your insurance company as will cover and what it soon as possible. will not. If your expenses become excessive, our Coordination of Benefits (COB) counselors will work with Coordination of Benefits, referred to as COB, is a term you to arrange payment used by insurance companies when you are covered for your services. Your under two or more insurance policies. This usually insurance coverage often happens when spouses or partners are listed on each has limitations and often other’s insurance policies, when both parents carry their does not pay the full children on their individual policies, or when there is amount of the bill. You eligibility under two federal programs. This also can may be responsible for occur when you are involved in a motor vehicle accident the remaining balance, and have medical insurance and automobile insurance. such as deductibles, Most insurance companies have COB provisions co-pays, penalties for that determine who is the primary payer when medical pre-existing conditions expenses are incurred. This prevents duplicate payments. or pre-certifications/ COB priority must be identified at admission in order to authorizations. comply with insurance guidelines. Your insurance may request a completed COB form before paying a claim, Call 989-907-7585 if and every attempt will be made to notify you if this you have any questions. occurs. The hospital cannot provide this information to your insurance company. You must resolve this issue with your insurance carrier in order for the claim to be paid.

Medicare We will need a copy of your Medicare card to verify eligibility and process your claim. You should be aware that the Medicare program specifically excludes payment for certain items and services, such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations and others. Deductibles and co- payments are the patient’s responsibility.

Ascension.org/Michigan 989-907-8000 : 29 Preparing to Leave the Hospital

If You Do Not Have Medicaid Insurance We will need a copy of your Medicaid card. Medicaid has If you are unable to pay payment limitations on a number of services and items. your hospital bill due to Medicaid does not pay for the cost of a private room financial hardship, then unless medically necessary. a financial counselor will perform a screening Commercial Insurance to see if you qualify for As a service to our customers, we will forward a claim additional assistance. to your commercial insurance carrier based on the If not, you can apply information you provide at the time of registration. It is for financial assistance very important for you to provide all related information through Ascension such as policy number, group number and the correct St. Mary’s. We are a mailing address for your insurance company. charitable, giving, not- for-profit organization Billing Process Summary that serves everyone in n After you are discharged from our facility, the Ascension need. You may qualify St. Mary’s billing department will process a statement to for full or partial financial your insurance company for all covered hospital services. assistance based on n We will bill your insurance company and will do established guidelines everything possible to help expedite your claim; that include patient’s however, please remember that your insurance policy is income level, assets, a contract between you and your insurance company. situation and number n After the insurance payments have been received by of people in the home, our facility, you then will receive statements from and other indicators Ascension St. Mary’s. These statements will inform of inability to pay. If you you of how much your insurance carrier paid and any are interested in filing remaining balance for which you are responsible. The for financial assistance, financial counseling department is willing to work please contact the with you to help resolve your account, and we have financial counseling several payment options available to assist you in office for additional paying your bill. assistance at 989-907-7585. n For all billing questions and concerns, please feel free to contact our billing office at 888-978-6279.

30 : Ascension.org/Michigan 989-907-8000 For the Caregiver Your role as a patient advocate. CAREGIVER... know what condition your loved one is being treated for.

patient’s rights Know your patient’s rights and responsibilities (See page 12).

advance directives Know whether or not your loved one has an advance directive, and if so, what it specifies (See page 20).

ask questions While your loved one is in the hospital, who will If your loved one is too ill or speak up for him or her? You can, by being the reluctant to ask questions, patient’s advocate—the person who will help the make note of his or her concerns patient work with doctors, nurses and hospital staff. and any you may have, and To help your loved one make the best decisions don’t be afraid to speak up about his or her care and treatment, follow the (See Speak Up! on page 15). advice in the caregiver list at right. While you are making sure that your loved one’s help track medications needs are being met, don’t neglect your own. Your loved one may be Caregiving is a stressful and time-consuming job. prescribed medications while You may neglect your diet, your normal exercise in the hospital and may be routine and your sleep needs. You may find that you seen by several doctors. have little or no time to spend with friends, to relax, or to just be by yourself for a while. what’s next? But downtime is important. Don’t be reluctant Will your loved one need home to ask for help in caring for your loved one. care or care at another facility? Take advantage of friends’ offers to help and look Ask to speak with a case manager into local adult daycare programs. Find out more to find out what your options are. about how you can ease the stress of caregiving at www.caregiver.org.

Ascension.org/Michigan 989-907-8000 : 31 Your Healthcare Team

It is the men and women of spiritual support person always is Ascension St. Mary’s—guided by faith welcome to visit. and values—that make the difference in delivering high-quality care. More Case Management Case managers than 2,200 people are employed in the work with you, your doctor and your Ascension St. Mary’s organization, and insurance company to evaluate the each employee is a valued member of services you need. They can assist you your healthcare team. Because your in many ways, including evaluating comfort and privacy are important to options for long-term treatment needs, us, our team members will try to be as assisting with arrangements for care sensitive as possible when our duties after your discharge from the hospital require us to enter your room. and making referrals to community resources. If you wish to speak with a Physicians At Ascension St. Mary’s, our case manager, please ask your nurse. medical staff consists of more than 400 primary care and specialty physicians, Volunteers Volunteers at Ascension St. representing all major specialties. Your Mary’s range from high school students physician is responsible for coordinating to seniors. They come with a variety of all aspects of your care while you are at skills, interests and abilities, including Ascension St. Mary’s. In addition to the retired professionals, college students physicians who you will meet in person, and working parents—all with one other specialists also may be involved main goal in mind: making a difference. in your care, including pathologists and If you are interested in volunteering at radiologists.

Nursing Team Ascension St. Mary’s has an outstanding group of dedicated nurses who coordinate patient care 24 hours a day, seven days a week. Our nurses are our patient’s primary advocates, keeping other staff members involved and informed while providing excellent continuity of care.

Chaplains Along with physical care, we believe spiritual support is important to the total health of our patients. Chaplains are on call to assist you whatever your faith tradition. For information, call ext. 5624. Your priest, pastor, rabbi or

32 : Ascension.org/Michigan 989-907-8000 Ascension St. Mary’s, please call the College of Medicine completing a Volunteer Services Office at ext. 8920. residency program. The residency programs include the following Students At Ascension St. Mary’s, we specialties: emergency medicine, internal strive to integrate education with healing. medicine, family medicine, gynecology During your stay, you may encounter and surgery. Residents at Ascension St. medical students, nursing and pharmacy Mary’s assist in providing patient care students, and students of other disciplines. under the guidance of a CMU faculty These students may assist with, but not member or other qualified member direct, your care and are closely supervised of Ascension St. Mary’s medical staff. by licensed professionals. We welcome them as part of our healthcare team. If Other Support Staff In addition you prefer that students not be a part of to physicians and nurses, many other your care, please inform your nurse or Ascension St. Mary’s support staff physician. members may be involved in your care, During your stay, you also may including respiratory therapists, physical encounter resident physicians. These therapists, lab personnel, housekeeping medical professionals have graduated and transport staff, and volunteers, from medical school and are physicians depending on your needs. who are participating in the CMU

Ascension.org/Michigan 989-907-8000 : 33 Making a Gift to Ascension St. Mary’s

Were you touched by the care you or a loved one received at our hospital? Did you encounter a caregiver who went the extra mile to make sure your needs were met? Do you want to give back so that future patients and families will continue to have the same exceptional care you experienced? Through the Grateful Hearts program, you can share your appreciation while making a difference in the health and well-being of your family and neighbors by making a contribution in recognition of an extraordinary caregiver. Your special caregiver will be sent a beautiful recognition card with your personalized message and a unique pin he or she can wear with pride. You also will be helping to fund life-saving care and mission-driven health and education programs throughout Ascension St. Mary’s. Whether you are a grateful patient, a family member or a friend, you can honor a caregiver today by completing the form below. Contact the foundation at 989-907-8300, if you would like to discuss additional giving options.

Name(s):______

Address:______City:______State:_____Zip:______

Phone:______Email:______

Please accept my gift of: ❍ $100 ❍ $50 ❍ $25 ❍ $10 ❍ Other $______

Gift designation: ❍ Where it is needed most ❍ Other

Payment method: ❍ Check Enclosed (payable to Ascension St. Mary’s Foundation) ❍ Donate online at www.stmarysofmichigan.org/foundation ❍ MasterCard ❍ VISA ❍ American Express ❍ Discover

Credit Card No.______Exp. Date______CVN______

Signature______

You may choose to include a message to your special caregiver(s) below. ______Please detach this page and give it to your attending nurse to deliver to the foundation. Ascension St. Mary’s Foundation 989-907-8300

34 : Ascension.org/Michigan 989-907-8000 Patient Satisfaction

Ascension St. Mary’s continually strives to provide excellent care to you and your family. Therefore, we have teamed up with Professional Research Consultants Inc. (PRC) to facilitate surveys about the care you’ve received here, which allows us to closely monitor patient satisfaction. A few days after your visit, your household may receive a phone call from a PRC representative asking you to participate in the survey and give feedback based on your experience. It only takes a few minutes, but it makes a great difference in helping us shape the future of healthcare services for you and other patients. If you are not surveyed but have comments you would like to share, please write or call our Patient Relations Coordinator at 989-907-7532.

Compliments? Concerns? Suggestions? Date: ______Room Number: ______Name: ______Address:______City:______State: ____ Zip: ______Telephone: ______

Please describe the problem or concern and be specific. ______

Please list staff, services or department involved if known. ______

Please suggest how you would like to see the problem resolved. ______

After completion of the form, please mail to: Ascension St. Mary’s Patient Relations Coordinator 800 S. Washington Ave. Saginaw, MI 48601

Ascension.org/Michigan 989-907-8000 : 35 Compliments and Concerns

Ethics Committee Our goal is to provide the best patient care. If at The Ascension St. Mary’s any time you have questions or concerns about the Ethics Committee and its quality of care that you or a family member is receiving consultation service or has received at our hospital, do not hesitate to speak is available to you and with your nurse or the nursing supervisor. If you feel your family to help with that your issue wasn’t resolved, please contact the difficult issues that may Patient Relations Coordinator at ext. 7532 with your arise in the course of compliments, complaints or concerns. You may call at your care. These issues any time during or after your stay. may include complex In addition, you have the right to file a complaint decision-making, or concern with either or both: forgoing or withdrawal of life-sustaining State of Michigan treatment and resolution Department of Licensing & Regulatory Affairs of conflicts. Ethics P.O. Box 30664 consults are available Lansing, MI 48909 24 hours a day, seven 800-882-6006 days a week. Your nurse www.michigan.gov/lara may assist you in requesting a consult Office of Quality and Patient Safety or the administrative The Joint Commission manager after hours One Renaissance Blvd. by dialing zero. Oakbrook Terrace, IL 60181 Fax: 630-792-5636 Website: www.jointcommission.org, then click “Report a Patient Safety Event”

36 : Ascension.org/Michigan 989-907-8000 Notice of Nondiscrimination

Ascension St. Mary’s complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Ascension St. Mary’s does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Ascension St. Mary’s: n provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters; and Written information in other formats (large print, audio, accessible electronic formats and other formats). n provides free language services to people whose primary language is not English, such as: Qualified interpreters; and Information written in other languages.

If you need these services, contact 989-907-8000 (TTY: 1-844-907-8000).

If you believe that Ascension St. Mary’s has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: Denise McLean Patient Relations Coordinator 800 S. Washington Ave. Saginaw, MI 48601 989-907-7532 Fax: 989-907-8143 [email protected]

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Denise McLean, Patient Relations Coordinator, is available to help you. You also can file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Ave. SW Room 509F, HHH Building Washington, DC 20201 1-800-368-1019; 1-200-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Ascension.org/Michigan 989-907-8000 : 37 Notice of Nondiscrimination ATTENTION: If you speak any of the languages below, language assistance services, free of charge, are available to you. Call 1-989-907-8000 (TTY: 1-844- 907-8000). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-989-907-8000 (TTY: 1-844-907-8000). ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 8000-907-989-1 )رقم هاتف الصم والبكم: 1-844-907-8000(.

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-989-907-8000（TTY: 1-844-907-8000）。 CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-989-907-8000 (TTY: 1-844-907-8000). KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-989-907-8000 (TTY: 1-844-907-8000). 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-989-907-8000 (TTY: 1-844-907-8000) 번으로 전화해 주십시오. ল嗍ষ্য ক쇁নঃ যদি আপনি বাংলা, কথা বলতে পারেন, তাহলে নিঃখরচা붼 ভাষা সহা붼তা পরিষেবা উপলব্ধ আছে। ফ�োন ক쇁ন 1-989-907-8000 (TTY: 1-844-907-8000)। UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-989-907-8000 (TTY: 1-844-907-8000). ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-989-907-8000 (TTY: 1-844-907-8000). ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-989-907-8000 (TTY: 1-844- 907-8000) 注意事項：日本語を話される場合、無料の言語支援をご利用いただけま す。1-989-907-8000 (TTY: 1-844-907-8000) まで、お電話にてご連絡ください。 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-989-907-8000 (телетайп: 1-844-907-8000). OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-989-907-8000 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-844-907-8000).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-989-907-8000 (TTY: 1-844-907-8000). 38 : Ascension.org/Michigan 989-907-8000 Notes

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Ascension.org/Michigan 989-907-8000 : 39 Notes

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40 : Ascension.org/Michigan 989-907-8000